with @cfmcquaid.bsky.social @tbtakenseriously.bsky.social Peter Cegielski @raclark18.bsky.social @jaseddon.bsky.social Leo Martinez Madhavi & Anurag Bhargava @richardwhite321.bsky.social @reinhouben.bsky.social @tb-lshtm.bsky.social @cmmid-lshtm.bsky.social @lshtm-tbmod.bsky.social

We think our recent review provides a better estimate of the RR leading to a much higher PAF, demonstrating the importance of addressing undernutrition to prevent TB.
academic.oup.com/ije/article/...

Estimating the PAF for a continuous measure is conceptually tricky, but 2024 estimates from WHO use a risk ratio which excludes several large studies, pools together different populations, and uses different comparators.

@cfmcquaid.bsky.social @tbtakenseriously.bsky.social @jaseddon.bsky.social @petedodd24.bsky.social @tb-lshtm.bsky.social #endtb

Key message: Eliminating undernutrition could prevent millions of people from developing TB. Scaling up nutritional interventions (which are likely to have myriad social and health benefits), particularly for
populations in greatest need, should be an integral part of the global TB response.

We estimated that eliminating moderate/severe undernutrition (BMI<17) would avert ~17% of global adult incidence, while eliminating all undernutrition (BMI<18.5) would avert ~27%, three times higher than current estimates.

We estimated that eliminating moderate/severe undernutrition (BMI<17) would avert ~17% of global adult incidence, while eliminating all undernutrition (BMI<18.5) would avert ~27%, three times higher than current estimates.

Key message: Addressing undernutrition must be central to the global TB response. #EndTB @cfmcquaid.bsky.social @reinhouben.bsky.social @raclark18.bsky.social @tb-lshtm.bsky.social

Based on these results and the global BMI distribution, we estimated a relative risk of tuberculosis associated with undernutrition of 5.0 (95% CI: 4.2–5.9), substantially higher than previous estimates.

Our results show how TB risk is highest at the lowest BMI values and decreases nonlinearly as BMI increases, with the steepest reduction in risk occurring when moving through underweight and normal weight ranges, and more modest reductions continuing through overweight and obese ranges.

We found an inverse, dose-response, nonlinear relationship between BMI and TB risk in the full underweight to obese range, consistent across populations and countries with a high versus lower TB burden.

Key message: Interventions to address household poverty and interrelated personal risk factors could substantially reduce TB burden in Peru. Our results inform intervention design; and support more effective implementation of poverty reduction/social protection within the global TB response.